What to expect when you're expecting.. in lockdown.
There’s obviously only one topic on most expectant parents (or anyone else for that matter) minds right now. So, in between delivering babies, we’ve compiled a two-part blog series. The first of these is focused on the questions we’re being asked right now. The answers to these questions are based on what we’re seeing and backed by great advice from The Royal College of Obstetricians & Gynaecologists and The NZ College of Midwives. Blog part 2 is focused on the importance of looking after ourselves in times like these.
Let’s start with the frequently asked questions:
Q1. What effect does Covid-19 have on pregnant women?
Generally, pregnant women do not appear to be more likely to be severely unwell than other healthy adults if they develop Covid-19. It is expected the large majority of pregnant women will experience only mild or moderate cold/flu like symptoms. More severe symptoms such as pneumonia appear to be more common in older people, those with weakened immune systems or pre-existing or underlying, chronic health conditions. As yet, there is no evidence that pregnant women who get this viral infection are more at risk of serious complications than any other healthy individuals.
Q2. Why are pregnant women in a vulnerable group?
Pregnancy in a small proportion of women can alter how your body handles severe viral infections. This is something that midwives and obstetricians have known for many years and are used to dealing with. As yet, there is no evidence that pregnant women who get this infection are more at risk of serious complications than any other healthy individuals. What has driven the decisions made by officials to place pregnant women in the vulnerable category is caution. We know that some viral infections are worse in pregnant women.
Q3. Will my antenatal appointments with my midwife look the same during this period?
If you have known Covid-19, are symptomatic or unwell in any other way, we will ask that you DO NOT attend clinic at this time. We will do a phone consult and recommend further steps. If you are well, most of us will recommend that if you are under 28 weeks you will only have a phone consult. If you are over 28 weeks, we will ask you to come to clinic, we will do a phone consult in your car then you will come into clinic. We will then do your urinalysis, take your blood pressure and assess your abdomen and listen to your baby. (Other midwives may do this slightly differently but the important part if there is reduced contact and only seeing you for essential parts of your care). You will still receive essential care at all times and all the relevant forms required for scripts, bloods and scans regardless of gestation.
Q4. What effect will Covid-19 have on my baby if I am diagnosed with the infection?
As this is a very new virus we are still learning about it. At this early stage, there is no evidence to suggest an increased risk of miscarriage. There is also no evidence that the virus can pass to your baby while you are pregnant or during birth (this is called vertical transmission). Two cases of possible vertical transmission have been reported. In both cases, it remains unclear whether transmission was prior to or soon after birth. Another recent report from China of four women who were coronavirus positive when they gave birth, found no evidence of the infection in their new-born babies. Expert opinion is that the baby is unlikely to be exposed during pregnancy. It’s also therefore considered unlikely, that if you have the virus, it would cause problems with the baby’s development, and no cases have been observed currently. Some babies born to women with symptoms of coronavirus in China have been born prematurely. It is unclear whether coronavirus caused early labour, or whether it was recommended that the baby was born early in order to preserve the mother’s health.
Q5. What can I do to reduce my risk of catching Covid-19? (Currently we are in Level 4, lockdown, but these are relevant to all levels of alert).
Regular hand washing
Use a tissue when you or anyone in your family coughs or sneezes, discard this and wash your hands
Avoid contact with someone who is displaying symptoms of coronavirus. These symptoms include high temperature and/or new and continuous cough
Avoid non-essential use of public transport when possible
Work from home, where possible.
Avoid large and small gatherings in public spaces, noting that all public spaces, are currently shut in New Zealand as infections spread easily in closed spaces where people gather together. This will still apply to pubs, gyms, malls and other spaces when the alert level drops down to 2 or 3.
Avoid gatherings with friends and family. Keep in touch using remote technology such as phone, internet, and social media
Use telephone or online services to contact your GP or other essential services
Q6. I am booked to give birth in a primary unit – can I still birth here?
Yes, if you are maintaining your health through the principles of the COVID-19 social distancing expectations (stay at home and physical distancing) and you are otherwise well, you should be able to labour and birth in a primary unit.
Q7. I want to birth in the hospital but I am considered low risk – will my midwife advise me to birth at home or in a primary unit to reduce the risk of COVID-19 transmission?
Rest assured that hospitals are undertaking stringent precautions to ensure that COVID-19 is not transmitted to staff or other hospital inpatients. Therefore it should not be necessary to change your planned place of birth – unless you are wanting to.
Q8. Can I still give birth in water?
Yes - if you have a) been staying at home and following the rules of social distancing (as per COVID alert level 4); and b) are not requiring self-isolation for possible exposure to COVID- 19, then there is no reason for you not to use water during birth. However, if you are in self- isolation for COVID-19 risk factors, or if you are a suspected or confirmed COVID-19 case, then you will be advised that using water during labour and birth is not recommended. This is because the virus can sometimes be found in faeces which can then be transmitted to the baby. It may also be more difficult for your midwife to use adequate protection equipment during a water birth.
Q9. Can I have an epidural during labour?
Yes; there is no evidence that women with suspected or confirmed COVID-19 cannot have an epidural or a spinal block.
Q10. Can I use Entonox (laughing gas) during my labour and birth?
Yes, unless you have suspect Covid-19 or have tested positive for this. The MOH have recently advised that this isn’t a suitable pain management method if you fall in to the latter category.
Q11. Can I still give birth in a hospital if I am diagnosed with COVID-19 infection?
The safest place to birth your baby is in a hospital if you have Covid-19, where you have access to highly trained staff and emergency facilities, if they are required. It is important to emphasise that a woman’s experience of labour and vaginal birth, or caesarean section, should not be significantly impacted and women should be encouraged, and supported, to approach this extraordinary time of their lives without fear or apprehension. Medical intervention, other than that specifically related to infection control, should not differ significantly from usual practice. Active mobilisation, use of water immersion in labour, nitrous oxide and epidural analgesia are not affected. If you are well and low risk as above, you may consider a homebirth or a birthing centre to keep yourself and reduce the load off the hospital.
Q12. Why is there a restriction on the number of support people allowed within most hospitals during this stage?
Within NZ, there is no one rule for all DHB’s, so do touch base with your health care provider to find out what your local hospital is enforcing. Overall there is limited access for support people; we understand that this is disheartening. We do know that we now have community spread, so to decrease the risk of this entering hospitals (to our most vulnerable) we have to be much more restrictive on who comes in. We know that people are asymptomatic for at least 2-3 days and can be spreading the virus. Within the Maternity ward there aren’t specific bathrooms and kitchens for designated support people so we further increase the risk of this spreading. And we can’t risk that.
Q13. Will my midwife be wearing personal protective equipment for my labour and birth now?
Yes - we are now required to wear full PPE for women who are in the established labour (including the pushing stage and delivery of your baby) whether this is at home, the birthing centre or hospital.
Q14. Do I need to have a caesarean section or interventional birth to reduce the risk of transmitting the virus to my baby?
There is no evidence that caesarean section or induction of labour is necessary to reduce the risk of vertical transmission. If a woman has COVID-19 infection, or has had significant exposure, unless there are immediate risks to her health, or other obstetric indications, elective caesarean section or induction of labour should be delayed, if possible.
Thanks, so much for reading. We hope this blog has been informative and helped put you and or your partner at ease. If we can help you by answering more questions, please let us know as we will be doing some live Q and A on Instagram this week. If we can help with advice, or expanding on anything covered in our blog please just touch base on our Instagram or Facebook page, or contacting us via www.hatchedantenatal.co.nz .